Associations between comorbidities, their treatment and survival in patients with interstitial lung diseases – a claims data analysis

Abstract

BackgroundInterstitial lung diseases (ILDs) are associated with a high burden of disease. However, data on the prognostic impact of comorbidities and comorbidity-related pharmaceutical treatments in patients with various ILDs remain sparse.MethodsUsing longitudinal claims data from a German Statutory Health Insurance Fund, we assessed comorbidity in ILD subtypes and associated drug treatments. Baseline comorbidity was assessed via the Elixhauser Comorbidity Index that was amended by ILD-relevant conditions. Drug treatment was assessed on the substance level using the ATC-codes of drugs prescribed at the time of ILD diagnosis. Subsequently, the comorbid conditions (main analysis) and pharmaceutical substances (secondary analysis) with a meaningful association to survival were identified for the complete ILD cohort and within the subtype strata. For this, we applied multivariate Cox models using a LASSO selection process and visualized the findings within comorbidomes.ResultsIn the 36,821 patients with ILDs, chronic obstructive pulmonary disease (COPD), arterial hypertension, and ischaemic heart disease (IHD) were the most prevalent comorbidities. The majority of patients with cardiovascular diseases received pharmaceutical treatment, while, in other relevant comorbidities, treatment quotas were low (COPD 46%, gastro-oesophageal reflux disease 65%). Comorbidities had a clinically meaningful detrimental effect on survival that tended to be more pronounced in the case of untreated conditions (e.g. hazard ratios for treated IHD 0.97 vs. 1.33 for untreated IHD). Moreover, comorbidity impact varied substantially between distinct subtypes.ConclusionsOur analyses suggest that comorbid conditions and their treatment profile significantly affect mortality in various ILDs. Therefore, comprehensive comorbidity assessment and management remains important in any ILD.Electronic supplementary materialThe online version of this article (10.1186/s12931-018-0769-0) contains supplementary material, which is available to authorized users.

Atrial arrhythmias in chronic lung disease‐associated pulmonary hypertension

“…One study found that up to 30% of patients with ILD are on BBs for the treatment of co-existing cardiovascular disease and 88.6% of ILD patients with cardiac arrhythmias were on BBs. 46 No study has reported on their efficacy. BBs have occasionally been associated with ILD development 53 but this is an extremely rare complication and should not impact acute AAs management.…”

“…This can worsen right ventricular systolic function through cardiac myofibril overdistention. As the right Olsson et al 14 Mercurio et al 44 Malacznska-Rajpold et al 36 Durheim et al 45 Schwarzkopf et al 46…”

Management of Fibrosing Interstitial Lung Diseases

“…For patients with HP, a thorough investigation for the inciting antigen should be performed and, if the antigen can be identified, the patient advised of the importance of antigen avoidance [86]. Management of extra-pulmonary manifestations of disease and identification and treatment of comorbidities can improve patient outcomes [87–89].…”

Effects of Vibration Training in Interstitial Lung Diseases: A Randomized Controlled Trial

“…Usually, in many fibrotic ILDs, disease progresses over time and is thus associated with worsened symptoms. ILD patients frequently suffer from comorbid conditions and consequences of the disease, such as pulmonary hypertension, arrhythmias, exercise-induced hypoxemia, and skeletal muscle weakness [4]. Historically, physical activity in patients with ILDs with breathlessness at resting conditions was not recommended.…”